Provider Demographics
NPI:1649297391
Name:JANNETTI, RAYMOND A (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:JANNETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3295
Mailing Address - Country:US
Mailing Address - Phone:315-455-7610
Mailing Address - Fax:315-455-7906
Practice Address - Street 1:2700 COURT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3295
Practice Address - Country:US
Practice Address - Phone:315-455-7610
Practice Address - Fax:315-455-7906
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162747207L00000X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013556Medicaid
NY01013556Medicaid
RB0793Medicare PIN
B81359Medicare UPIN